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Ask Dr. Sears: Exposure to Unvaccinated Children

Q. My brother's children are 3 and 5 years old, and neither of them have gotten their immunizations yet. The 5-year-old will be starting school this year, so he'll have to get his vaccines soon, but the younger child won't. I am expecting a baby in a couple of weeks. I was wondering what the dangers are, and whether it's safe to expose my newborn to his cousins?

A. The great majority of patients in our pediatric practice are fully immunized, but we do see an occasional family who chooses not to vaccinate their children. Though I respect this decision, I don't agree with it. I encourage parents to get all the immunizations recommended by the American Academy of Pediatrics. When I began practicing 35 years ago, many of the vaccines we have today did not exist. I remember starting each day with hospital rounds to care for patients with meningitis caused by hemophilus influenza B (now preventable by the HIB vaccine), measles, encephalitis (preventable by MMR  -- measles, rumps, rubella vaccine), pneumonia (preventable by Prevnar or pneumococcus vaccine), chicken pox complications, such as pneumonia (preventable by the chicken pox vaccine), and infants with breathing difficulties secondary to whooping cough. And I recall seeing infants born with malformations of the brain and heart because the mother was exposed to the German measles (rubella) during pregnancy. Nowadays, it's rare to see a child with these infectious diseases. And even when the occasional child contracts one, hospitalization is seldom required.

I don't want to see history repeat itself and that's why I support the current immunization program. Infants and children are much healthier because of it. While it's necessary for you to accept your brother's decision for the sake of family harmony, consider these points:

There's no need to worry about exposing your newborn. Chances are great that your brother's kids won't be contagious with any of the illnesses mentioned above. For any immunization program to be effective, herd immunity must take place. This means that if the great majority of the population is immunized (80 percent or higher), there are not enough non-immunized people to support the growth of the germ, and the disease is eventually eradicated. A classic example of herd immunity is the smallpox vaccination program. Thanks to worldwide immunizations, smallpox is no longer a threat. (Many people in older generations still bear a dime-size smallpox-vaccination scar on their arms.) I suspect the polio vaccine will be the next to be eliminated from the immunization schedule. Because most everyone in your brother's neighborhood has likely been vaccinated, his children can get by without immunization. But consider what would happen if most parents in your town decided not to immunize their children. The "herd" would then be vulnerable to infectious diseases, and another epidemic could recur.

Your brother could selectively immunize his children. Some parents, and even some pediatricians, have concerns about overwhelming an infant's already immature immune system with five or six vaccines at a single office visit. Although there is no compelling scientific evidence that giving multiple vaccines at once does any harm, in our practice we alleviate worries by giving patients two vaccines at each scheduled well-baby office visit, and having them return a month or so later for two more vaccines. The one problem with changing the immunization schedule is that parents sometimes forget to bring their child back for a second round of shots. Nevertheless, your brother may want to consider this option.

It's good to think outside the box. With the growing trend toward global travel and the increasing number of infants in crowded daycare centers, immunizations are perhaps even more important today than they were in the past.

Be discerning about what you read. Vaccine fears make headlines, and the present controversy is nothing new. During my many years as a pediatrician, there has been a new worry about a certain vaccine every decade  -- and it takes another decade to prove the worry wrong. The DPT vaccine, for example, was thought to cause SIDS (sudden infant death syndrome). It took ten years to prove that there was no correlation. Next came the measles vaccine/autism scare. Recent studies have failed to confirm any correlation there, either. Unfortunately, these controversies frighten parents who want the best for their baby  -- they end up feeling guilty if they don't vaccinate, but worry excessively if they do. If you are concerned about any particular vaccine, ask your doctor to explain the health benefits as well as the risks.